title: Measuring the impact of the Thoracolumbar Injury Classification and Severity Score among 458 consecutively treated patients.
abstract: BACKGROUND
  The Thoracolumbar Injury Classification and Severity Score (TLICS) was proposed to improve injury classification and guide surgical decision-making of thoracolumbar spinal trauma (TLST), but its impact on the care of patients has not been quantified.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Analysis of 458 patients treated for TLST trauma from 2000 through 2010 at a single center. Outcome measures Neurological status - ASIA Impairment Scale (AIS), failure of conservative treatment, and surgical complications.
  
  
  METHODS
  Clinical and radiological data were evaluated. Patients were grouped according to the period before (2000-2006) and after (2007-2010) utilization of the TLICS.
  
  
  RESULTS
  From 2000 to 2006, 148 patients were initially treated conservatively (C) and 66 were surgically (S) treated. In the C group, the TLICS ranged from 1 to 7 (median 1; mean 1.57). In the S group, the TLICS ranged from 2 to 10 (median 2; mean 4.14). The TLICS matched treatment in 97.9% of conservatively treated patients. From 2007 to 2010, 162 patients were initially treated C and 82 were treated S. In the C group, the TLICS ranged from 1 to 4 (median 1; mean 1.48). In the S group, the TLICS ranged from 2-10 (median 4; mean 4.4). The TLICS matched treatment in 98.8% of C-treated patients. Overall, failure of C treatment occurred in nine patients; most failures (7/9) and all three missed distractive injuries occurred prior to use of the TLICS.
  
  
  CONCLUSIONS
  After introduction of the TLICS, there was a trend towards more successful conservative treatment with fewer conversions to surgical treatment.
authors.forename: Andrei F
authors.initials: AF
authors.lastname: Joaquim
authors.forename: Brandon
authors.initials: B
authors.lastname: Lawrence
authors.forename: Michael
authors.initials: M
authors.lastname: Daubs
authors.forename: Darrel
authors.initials: D
authors.lastname: Brodke
authors.forename: Helder
authors.initials: H
authors.lastname: Tedeschi
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology*; D055815:Young Adult
keywords: American Spinal Injury Association; Burst fractures; Fractures; Magerl/AO Spine Classification; Spinal cord injuries; Spinal surgery; Spinal trauma; Thoracolumbar Injury Classification and Severity Score; Vertebral